Pulmonary Function and Radiologic Features in Survivors of Critical COVID-19: A 3-Month Prospective Cohort.
Aftercare
/ methods
COVID-19
/ complications
Female
Humans
Intensive Care Units
/ statistics & numerical data
Long Term Adverse Effects
/ diagnosis
Lung
/ diagnostic imaging
Male
Middle Aged
Outcome Assessment, Health Care
Patient Discharge
/ statistics & numerical data
Prevalence
Quality of Life
Respiratory Function Tests
/ methods
SARS-CoV-2
Spain
/ epidemiology
Survivors
/ psychology
Tomography, X-Ray Computed
/ methods
Walk Test
/ methods
COVID-19
CT abnormalities
ICU
SARS
SARS-CoV-2
lung function
sequelae
Journal
Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335
Informations de publication
Date de publication:
07 2021
07 2021
Historique:
received:
14
10
2020
revised:
12
02
2021
accepted:
25
02
2021
pubmed:
8
3
2021
medline:
21
7
2021
entrez:
7
3
2021
Statut:
ppublish
Résumé
More than 20% of hospitalized patients with COVID-19 demonstrate ARDS requiring ICU admission. The long-term respiratory sequelae in such patients remain unclear. What are the major long-term pulmonary sequelae in critical patients who survive COVID-19? Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated 3 months after hospitalization discharge. The follow-up comprised symptom and quality of life, anxiety and depression questionnaires, pulmonary function tests, exercise test (6-min walking test [6MWT]), and chest CT imaging. One hundred twenty-five patients admitted to the ICU with ARDS secondary to COVID-19 were recruited between March and June 2020. At the 3-month follow-up, 62 patients were available for pulmonary evaluation. The most frequent symptoms were dyspnea (46.7%) and cough (34.4%). Eighty-two percent of patients showed a lung diffusing capacity of less than 80%. The median distance in the 6MWT was 400 m (interquartile range, 362-440 m). CT scans showed abnormal results in 70.2% of patients, demonstrating reticular lesions in 49.1% and fibrotic patterns in 21.1%. Patients with more severe alterations on chest CT scan showed worse pulmonary function and presented more degrees of desaturation in the 6MWT. Factors associated with the severity of lung damage on chest CT scan were age and length of invasive mechanical ventilation during the ICU stay. Three months after hospital discharge, pulmonary structural abnormalities and functional impairment are highly prevalent in patients with ARDS secondary to COVID-19 who required an ICU stay. Pulmonary evaluation should be considered for all critical COVID-19 survivors 3 months after discharge.
Sections du résumé
BACKGROUND
More than 20% of hospitalized patients with COVID-19 demonstrate ARDS requiring ICU admission. The long-term respiratory sequelae in such patients remain unclear.
RESEARCH QUESTION
What are the major long-term pulmonary sequelae in critical patients who survive COVID-19?
STUDY DESIGN AND METHODS
Consecutive patients with COVID-19 requiring ICU admission were recruited and evaluated 3 months after hospitalization discharge. The follow-up comprised symptom and quality of life, anxiety and depression questionnaires, pulmonary function tests, exercise test (6-min walking test [6MWT]), and chest CT imaging.
RESULTS
One hundred twenty-five patients admitted to the ICU with ARDS secondary to COVID-19 were recruited between March and June 2020. At the 3-month follow-up, 62 patients were available for pulmonary evaluation. The most frequent symptoms were dyspnea (46.7%) and cough (34.4%). Eighty-two percent of patients showed a lung diffusing capacity of less than 80%. The median distance in the 6MWT was 400 m (interquartile range, 362-440 m). CT scans showed abnormal results in 70.2% of patients, demonstrating reticular lesions in 49.1% and fibrotic patterns in 21.1%. Patients with more severe alterations on chest CT scan showed worse pulmonary function and presented more degrees of desaturation in the 6MWT. Factors associated with the severity of lung damage on chest CT scan were age and length of invasive mechanical ventilation during the ICU stay.
INTERPRETATION
Three months after hospital discharge, pulmonary structural abnormalities and functional impairment are highly prevalent in patients with ARDS secondary to COVID-19 who required an ICU stay. Pulmonary evaluation should be considered for all critical COVID-19 survivors 3 months after discharge.
Identifiants
pubmed: 33676998
pii: S0012-3692(21)00464-5
doi: 10.1016/j.chest.2021.02.062
pmc: PMC7930807
pii:
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
187-198Investigateurs
Rosario Amaya Villar
(RA)
José M Añón
(JM)
Carme Barberà
(C)
José Barberán
(J)
Aaron Blandino Ortiz
(AB)
Elena Bustamante-Munguira
(E)
Jesús Caballero
(J)
Cristina Carbajales
(C)
Nieves Carbonell
(N)
Mercedes Catalán-González
(M)
Cristóbal Galbán
(C)
Victor Daniel Gumucio
(VD)
Maria Del Carmen de la Torre
(MDC)
Emili Díaz
(E)
Ángel Estella
(Á)
Elena Gallego
(E)
José Luis García Garmendia
(JL)
José Garnacho-Montero
(J)
José M Gómez
(JM)
Arturo Huerta
(A)
Ruth Noemí Jorge García
(RN)
Ana Loza-Vázquez
(A)
Judith Marin-Corral
(J)
Amalia Martínez de la Gándara
(AM)
Ignacio Martínez Varela
(IM)
Juan Lopez Messa
(JL)
Guillermo M Albaiceta
(GM)
Mariana Andrea Novo
(MA)
Yhivian Peñasco
(Y)
Juan Carlos Pozo-Laderas
(JC)
Pilar Ricart Martí
(PR)
Ferran Roche-Campo
(F)
Angel Sánchez-Miralles
(A)
Susana Sancho Chinesta
(SS)
Lorenzo Socias
(L)
Jordi Solé-Violan
(J)
Fernando Suares Sipmann
(FS)
Luis Tamayo Lomas
(LT)
José Trenado
(J)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
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